Giovanni Donato Aquaro1, Francesco Negri2, Antonio De Luca2, Giancarlo Todiere3, Francesco Bianco4, Andrea Barison3, Giovanni Camastra5, Lorenzo Monti6, Santo Dellegrottaglie7, Claudio Moro8, Chiara Lanzillo9, Alessandra Scatteia10, Mauro Di Roma11, Gianluca Pontone12, Martina Perazzolo Marra13, Gianluca Di Bella14, Rocco Donato14, Chrysanthos Grigoratos15, Michele Emdin16, Gianfranco Sinagra2. 1. Fondazione Toscana G.Monasterio, Pisa, Italy. Electronic address: aquaro@ftgm.it. 2. Cardiovascular Department "Ospedali Riuniti" of Trieste and Post Graduated School of Cardiovascular Sciences, University of Trieste, Trieste, Italy. 3. Fondazione Toscana G.Monasterio, Pisa, Italy. 4. University of Chieti, Chieti, Italy. 5. Cardiac Department, Vannini Hospital Rome, Roma, Italy. 6. Radiology Department, Humanitas Research Hospital, I.R.C.C.S, Rozzano, (Milan), Italy. 7. Division of Cardiology, Villa dei Fiori, Acerra, Napoli, Italy; Mount Sinai School of Medicine, New York, USA. 8. U.O. Cardiologia e UTIC, ASST Monza, P.O. Desio, Italy. 9. Cardiology Department, Policlinico Casilino, Rome, Italy. 10. Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy. 11. Radiological Department, European Hospital, Roma, Italy. 12. Cardiac Department, Centro Cardiologico Monzino, Milano, Italy. 13. Division of Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy. 14. Clinical and Experimental Department of Medicine, University of Messina, Messina, Italy. 15. Scuola Superiore di Perfezionamento Sant'Anna, Pisa, Italy. 16. Fondazione Toscana G.Monasterio, Pisa, Italy; Scuola Superiore di Perfezionamento Sant'Anna, Pisa, Italy.
Abstract
OBJECTIVES: Right ventricular (RV) myocarditis (MY) is unrecognized, and its prevalence is unknown. We evaluated the prevalence of RV involvement in acute MY and its association with cardiac events (cardiac death, cardiac arrest, ventricular assist device, transplantation, and appropriate ICD intervention). METHODS: We enrolled 151 patients who underwent cardiac magnetic resonance for clinical suspicion of acute MY. The CMR protocol included T2-STIR images for edema detection, post-contrast cine-SSFP for hyperemia detection and late gadolinium enhancement (LGE) images. RESULTS: Signs of RV MY were found in 27 patients (17.8%): RV edema at T2-STIR in all of these 27 patients; RV LGE was detected in 11 patients (7.3%). The median RV myocardial segment involved was 2 (1-3). In 13 patients, RV edema was in direct continuity with LV edema of septum and inferior wall or with anterior septum and anterior wall. In 2 patients RV myocarditis was found without any signs of LV involvement. Patients with RV MY had higher RV end-diastolic volume index (p = 0.04) and RV mass index (p = 0.03), and lower RV ejection fraction (p < 0.001) than others. At Kaplan-Meier survival curve patients with RV MY had more cardiac events than those without RV involvement (p = 0.015). RV involvement, anteroseptal LGE and RV LGE were associated with cardiac events. CONCLUSION: RV involvement in acute MY is more frequent than previously hypothesized. RV MY was associated with cardiac events.
OBJECTIVES: Right ventricular (RV) myocarditis (MY) is unrecognized, and its prevalence is unknown. We evaluated the prevalence of RV involvement in acute MY and its association with cardiac events (cardiac death, cardiac arrest, ventricular assist device, transplantation, and appropriate ICD intervention). METHODS: We enrolled 151 patients who underwent cardiac magnetic resonance for clinical suspicion of acute MY. The CMR protocol included T2-STIR images for edema detection, post-contrast cine-SSFP for hyperemia detection and late gadolinium enhancement (LGE) images. RESULTS: Signs of RV MY were found in 27 patients (17.8%): RVedema at T2-STIR in all of these 27 patients; RV LGE was detected in 11 patients (7.3%). The median RV myocardial segment involved was 2 (1-3). In 13 patients, RVedema was in direct continuity with LV edema of septum and inferior wall or with anterior septum and anterior wall. In 2 patientsRVmyocarditis was found without any signs of LV involvement. Patients with RV MY had higher RV end-diastolic volume index (p = 0.04) and RV mass index (p = 0.03), and lower RV ejection fraction (p < 0.001) than others. At Kaplan-Meier survival curve patients with RV MY had more cardiac events than those without RV involvement (p = 0.015). RV involvement, anteroseptal LGE and RV LGE were associated with cardiac events. CONCLUSION:RV involvement in acute MY is more frequent than previously hypothesized. RV MY was associated with cardiac events.
Authors: Hezzy Shmueli; Maulin Shah; Joseph E Ebinger; Long-Co Nguyen; Fernando Chernomordik; Nir Flint; Patrick Botting; Robert J Siegel Journal: Int J Cardiol Heart Vasc Date: 2021-01-25
Authors: Alexander Schmeißer; Thomas Rauwolf; Thomas Groscheck; Katharina Fischbach; Siegfried Kropf; Blerim Luani; Ivan Tanev; Michael Hansen; Saskia Meißler; Kerstin Schäfer; Paul Steendijk; Ruediger C Braun-Dullaeus Journal: ESC Heart Fail Date: 2021-05-02